Objectives: This project identifies and describes disparities associated with pneumococcal vaccination among rural elderly adults. The study focuses on variation in the delivery of vaccinations based on provider types and characteristics including geographic location focused on rural and urban disparities.

Background: Community-acquired pneumonia (CAP) poses a considerable threat to the health of older adults, with the incidence of CAP increasing dramatically among those aged 65 years and older. Mortality for invasive pneumococcal disease also increases with age, doubling from age 65 (20%) to age 85 (40%). Streptococcus pneumonia (pneumococcus) is a leading infectious cause of illness, including bacteremia, meningitis, and pneumonia, accounting for up to 50% of all cases. Use of a 7-valent pneumococcal conjugate vaccine (PCV7) and, more recently, PCV13 among children has reduced pneumococcal infections among children and indirectly among adults. In August 2014, the Advisory Committee on Immunization Practices (ACIP) recommended routine use of 13-valent pneumococcal conjugate vaccine (PCV13) for all adults aged 65 years and older, regardless of prior vaccine use. National estimates show that only 20% of eligible adults are currently vaccinated, and prior research on barriers to vaccination found that rural elderly minorities are significantly less likely to receive vaccinations. The new 2014 ACIP recommendation for all adults aged 65 and older to receive PCV13 provides a unique opportunity to observe the provider characteristics associated with vaccine administration and to identify disparities and barriers to pneumococcal vaccine provision in the elderly adult population.

Data: The data are from the Medicare Physician and Other Supplier Public Use File (PUF) that provides information on services and procedures provided to Medicare beneficiaries by physicians and other health care professionals (including pharmacies and nurse practitioners). The PUF data contain information on utilization, payment and charges by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service for all providers delivering services to fee-for-service Medicare recipients. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries. The data in the Physician and Other Supplier PUF covers calendar years 2012 through 2014 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

Methods: We present descriptive statistics and geographic map visualizations at the county level for each state, as well as regression models predicting county-level vaccination rates. Explanatory factors include provider characteristics (provider type, credentials, place of service, rurality (RUC codes)) and county characteristics.